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<br />_A CORDTM CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MM/DDfYYYY) <br />02/26/2008 <br />PRODUCER (949) 553-0039 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Kelly Campbell Insurance Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 2195 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, <br />Costa Mesa CA 92628- INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Golden Eaq1e Ins. <br />CR coatings Inc. INSURER B: Delos Ins. Co. /KRM <br />12602 Newcomb Ave. INSURER c: <br /> INSURER D: <br />La Mirada CA 90638- INSURER E: <br /> <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR ADD'L POLICY NUMBER P~k+~~~~~68~ P~~'fJ(t~~t~N LIMITS <br />LTR INSRD TYPE OF INSURANCE <br /> ~ERAL LIABILITY GL8385312 01/31/2008 01/31/2009 EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY ~~~~~H9E~~~~r~ence) $ 100,000 <br />A W CLAIMS MADE [jJ OCCUR / / / / MED EXP (AnV one person) $ 5,000 <br /> I-- <br /> PERSONAL & ADV INJURY $ 1,000,000 <br /> / / / / GENERAL AGGREGATE $ 2,000,000 <br /> n'L AGGREn LIMIT AnS PER PRODUCTS - COMP/OP AGG $ 2,000,000 <br /> PRO- i,",:""\1l -" / / <br /> POLICY JECT LOC ~ 'l'It"'l <br /> ~TOMOBILE LIABILITY ~ . ~ JI / / / COMBINED SINGLE LIMIT <br /> ~.7. 7EJ 0'(:, 'lot (Ea accident) $ <br /> I-- ANY AUTO <br /> I-- ALL OWNED AUTOS l iFlISi'tt.'1ANi\( ER / / BODILY INJURY <br /> (Per person) $ <br /> I-- SCHEDULED AUTOS <br /> HIRED AUTOS / / / / BODILY INJURY <br /> I-- $ <br /> NON,OWNED AUTOS (Per accident) <br /> I-- <br /> / / / / PROPERTY DAMAGE <br /> (Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY, EA ACCIDENT $ <br /> R ANY AUTO / / / / OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> OESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ <br /> OCCUR 0 CLAIMS MADE AGGREGATE $ <br /> $ <br /> H DEDUCTIBLE / / / / $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND 01DKRM12002823 01/31/2008 01/31/2009 \ WC STATU" \ 10TH, <br /> X TORY LIMITS ER <br /> EMPLOYERS' LIABILITY SC,A~Jt'JED <br /> ANY FROPRIGOR/PARTN:OR/EXEC:UTIVE E,L. EACH ACCIDENT $ 1,000,000 <br />B OFFICER/MEMBER EXCLUDED? / / / / E,L. DISEASE, EA EMPLOYEE $ 1,000,000 <br /> If yes, describe under 1 M i n ~ " "lnno 1,000,000 <br /> SPECIAL PROVISIONS below EL, DISEASE, POLICY LIMIT $ <br /> OTHER nnl\ .J. 0 L\JUU / / / / <br /> / / / / <br /> Finance/Risk Mgmt / / / / <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />certificate holder is being named as Additional Insured for GL ONLY as their interest may appear. <br />*10 days notice for cancellation of non-payment of premium. <br /> <br />CANCELLATION <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT <br />FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR L1i1"LlTY OF ANY KIND UPON THE <br />INSURER, ITS AGENTS OR R RESE TIVES, / <br />AUTHORIZED REPR€ 'e E <br /> <br /> <br />Page 1 01 2 <br /> <br />COVERAGES <br /> <br />CERTIFICATE HOLDER <br />( ) <br /> <br />Attn: David G Dewey <br /> <br />\ I . ,. <br />City of Riverside Finance/purchasing <br />3900 Main st. <br /> <br />Riverside <br />ACORD 25 (2001/08) <br />U. _ INS025 (0108),05 <br />l'flTM <br /> <br />CA 92522- <br /> <br />ELECTRONIC LASER FORMS, INC, - (800)327-0545 <br />